|Publication number||US8034099 B2|
|Application number||US 12/057,032|
|Publication date||Oct 11, 2011|
|Filing date||Mar 27, 2008|
|Priority date||Mar 27, 2008|
|Also published as||EP2268235A2, EP2268235A4, US20090248139, WO2009120458A2, WO2009120458A3|
|Publication number||057032, 12057032, US 8034099 B2, US 8034099B2, US-B2-8034099, US8034099 B2, US8034099B2|
|Original Assignee||Medtronic Vascular, Inc.|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (12), Classifications (15), Legal Events (2)|
|External Links: USPTO, USPTO Assignment, Espacenet|
The present invention is directed to a stent prosthesis for use in a body lumen. More particularly, the present invention is directed to a stent prosthesis design to induce flaring of select stent crowns.
Heart disease, specifically coronary artery disease, is a major cause of death, disability, and healthcare expense in the United States and other industrialized countries. A number of methods and devices for treating coronary heart disease have been developed, some of which are specifically designed to treat the complications resulting from atherosclerosis and other forms of coronary arterial narrowing.
One method for treating such conditions is percutaneous transluminal coronary angioplasty (PTCA). Generally, PTCA is a procedure that involves passing a balloon catheter over a guidewire to a stenosis with the aid of a guide catheter. The stenosis may be the result of a lesion such as a plaque or thrombus. The guidewire extends from a remote incision to the site of the stenosis, and typically across the lesion. The balloon catheter is passed over the guidewire, and ultimately positioned across the lesion. Once the balloon catheter is appropriately positioned across the lesion, e.g., under fluoroscopic guidance, the balloon is inflated to break-up the plaque of the stenosis to thereby increase the vessel cross-section. The balloon is then deflated and withdrawn over the guidewire into the guide catheter to be removed from the body of the patient. In many cases, a stent or other prosthesis must be implanted to provide permanent support for the vessel. Stent prostheses are known for implantation within body lumens to provide artificial radial support to the wall tissue, which forms the various lumens within the body, and often more specifically, for implantation within the blood vessels of the body. Stents are typically constructed of a metal or polymer and are generally a hollow cylindrical shape. When such a device is to be implanted, a balloon catheter, typically carrying a stent on its balloon, is deployed to the site of the stenosis. The balloon and accompanying stent are positioned at the location of the stenosis, and the balloon is inflated to circumferentially expand and thereby implant the stent. Thereafter, the balloon is deflated and the catheter and the guidewire are withdrawn from the patient.
Recently, flexible stented valve prostheses and various delivery devices have been developed so that replacement valves can be delivered transvenously using a catheter-based delivery system. These stented valves may include a collapsible valve attached to the interior of a tubular frame or stent. The stented valves may also have a tubular portion or “stent graft” that can be attached to the interior or exterior of the stent to provide a generally tubular internal passage for the flow of blood when the leaflets are open. The graft can be separate from the valve and it can be made from any suitable biocompatible material including, but not limited to, fabric, a homograft, porcine vessels, bovine vessels, and equine vessels. The stent portion of the device can be reduced in diameter, mounted on a catheter, and advanced through the circulatory system of the patient. The stent portion can be either self-expanding or balloon expandable. In either case, the stented valve can be positioned at the delivery site, where the stent portion is expanded against the wall of a previously implanted prostheses or a native vessel to hold the valve firmly in place. The valve survives the compression and subsequent expansion in fully working form. One embodiment of a stented valve is disclosed in U.S. Pat. No. 5,957,949 titled “Percutaneous Placement Valve Stent” to Leonhardt et al., the contents of which are incorporated by reference herein in its entirety. Although the valve may later require replacement, the patient may receive multiple replacement valves using the minimally invasive catheter method rather than requiring further invasive surgery.
Stents prostheses, including those used in percutaneous heart valve applications, often do not have vessel fixation properties other than providing a coaxial interference fit into the target vessel or location. It is thus an object of the present invention to improve stent retention within a body lumen.
Embodiments of the present invention relate to a stent for use within a body lumen, the stent including a stent strut having a sinusoidal pattern of straight segments and crowns. All of the crowns of the stent strut are approximately parallel with a longitudinal axis of the stent when the stent is in an unexpanded configuration for delivery within the body lumen. The stent also includes a Y-shaped member attached to at least one crown of the stent strut such that the Y-shaped member is substantially centered within the at least one crown and the straight segments that extend from the at least one crown. When the stent is in an expanded configuration for contacting a vessel wall of the body lumen the at least one crown having the Y-shaped member attached thereto radially flares outward from an outer surface of the stent such that the at least one crown is at an acute angle with respect to the longitudinal axis of the stent.
The foregoing and other features and advantages of the invention will be apparent from the following description of the invention as illustrated in the accompanying drawings. The accompanying drawings, which are incorporated herein and form a part of the specification, further serve to explain the principles of the invention and to enable a person skilled in the pertinent art to make and use the invention. The drawings are not to scale.
Specific embodiments of the present invention are now described with reference to the figures, wherein like reference numbers indicate identical or functionally similar elements. The terms “distal” and “proximal” are used in the following description with respect to a position or direction relative to the treating clinician. “Distal” or “distally” are a position distant from or in a direction away from the clinician. “Proximal” and “proximally” are a position near or in a direction toward the clinician.
The following detailed description is merely exemplary in nature and is not intended to limit the invention or the application and uses of the invention. Although the description of the invention is in the context of treatment of blood vessels such as the coronary, carotid and renal arteries, the invention may also be used in any other body passageways where it is deemed useful. Furthermore, there is no intention to be bound by any expressed or implied theory presented in the preceding technical field, background, brief summary or the following detailed description.
Embodiments of the present invention relate to a generally tubular, cylindrical stent prosthesis in which select crowns of a stent strut flare radially outward at an angle from the cylindrical stent body upon expansion of the stent. A Y-shaped member is attached to one or more crown(s) to induce crown flaring. When the stent is in the unexpanded delivery configuration, all of the stent crowns are approximately parallel with a longitudinal axis of the stent. Upon expansion of the stent, the crown(s) having Y-shaped members attached thereto are angled with respect to the longitudinal axis and radially flare from the cylindrical stent body. The flared crowns may operate to anchor or retain the stent within the vessel by protruding into the vessel wall and/or seating the stent within an ostium of a body lumen. The flared crowns may additionally or alternatively operate to contain or “jail” plaque, to pry open an occlusion, to create an ostia, and/or to ease the crossing of another device. In one embodiment, the stent prosthesis is balloon expandable. Further details and description of the embodiments of the present invention are provided below with reference to
Cylindrical rings 108 are formed from stent struts 110 having a wavelike or sinusoidal pattern of straight segments 116 with crowns 112 (i.e., alternating turns facing opposite longitudinal directions) connecting adjacent straight segments 116. As shown in
Stent 100 may include a valve (not shown) therein capable of blocking flow in one direction to regulate flow there through. The valve would be sealingly and permanently attached to the interior surface of the stent and/or graft material enclosing or lining the stent. The graft material may be a low-porosity woven fabric, such as polyester, Dacron fabric, or PTFE, which creates a one-way fluid passage when attached to the stent. The valve may be a bovine or porcine valve treated and prepared for use in a human, or may be a mechanical valve or a synthetic leaflet valve. For example, a percutaneously implanted bovine or porcine valve treated and prepared for use in a human may be sewn inside a laser-welded stent such as that described in U.S. Pat. No. 5,957,949 titled “Percutaneous Placement Valve Stent” to Leonhardt et al., the contents of which are incorporated by reference herein in its entirety.
Stent 100 has an unexpanded configuration sufficient for delivery to the treatment site and an expanded or deployed configuration in which stent 100 comes into contact with the vessel wall. Stent 100 may be expanded in several ways. In one embodiment which will be explained in more detail herein, stent 100 may be balloon-expandable. Stent 100 may be collapsed to a contracted or compressed configuration on top of a balloon of a balloon dilation catheter for delivery to a treatment site, such as the type of balloon used in an angioplasty procedure. As the balloon expands, it physically forces stent 100 to radially expand such that the outside surface of stent 100 comes into contact with the lumen wall. The balloon is then collapsed leaving stent 100 in the expanded or deployed configuration.
Referring now to
The relationship between geometry of Y-shaped member 120 and the geometry of stent strut 110 determines the amount or degree of flare. More particularly, as stent 100 is expanded, angle AS of crown 112 and angle AB of V-shaped base 222 are increased. By design, the geometry of V-shaped base 222 leads to a more rapid increase in the angle AB as compared to the increase of angle AS of crown 112, and therefore leads to a disparity between the foreshortening of V-shaped base 222 and crown 112. Stated another way, since length LB of V-shaped base 222 is considerably shorter than length LS of straight segment 116, a greater angular change occurs at apex 228 of V-shaped base 222 than at crown 112 during deployment. The greater foreshortening rate of V-shaped base 222 imparts a tensile force to the inside curve of crown 112 via tether 230 to pull crown 112 both radially and axially, which results in the desired flaring behavior. The greater the ratio between LS to LB, the greater the difference in the respective foreshortening of the V-shaped base 222 and crown 112, and therefore the greater the resulting flare effect. During expansion, angle AB of V-shaped base 222 may approach 180 degrees such that Y-shaped member 120 transforms to a T-shape as shown in
Further, the cross-sectional thickness of stent strut 110 can influence the amount of flare. More particularly,
Y-shaped member 120 may be attached to any crown 112 that is to be flared upon expansion. In one embodiment, the outermost crowns at the proximal and/or distal ends of the stent may be flared in order to prevent stent migration, particularly when the stent is seated within an ostium of a vessel. Flow through a “straight” stent is primarily directed straight through. However, due to the relatively smaller inlet of a “straight” stent, some of the flow “misses” the inlet and swirls/rolls off the sides of the proximal end of the stent. Similarly, due to the relatively smaller outlet of a “straight” stent, some of the flow reverses and swirls/rolls off the sides of the distal end of the stent. Such swirling/rolling flow may cause unwanted rotational migration of the stent, as well as a phenomenon known as “watermelon seeding” which causes the stent to migrate distally an unpredictable distance. In comparison, a stent having flared ends may avoid such unwanted migration, as well as prevent hemostasis and subsequent thrombogenic effects. Due to the relatively larger inlet of a flared inlet end, the flow is directed straight through the proximal end of the stent without some of the flow missing the inlet. Similarly, due to the relatively larger outlet of a flared outlet end, the flow is directed straight out of the distal end of the stent without some of the flow reversing back towards the stent.
As previously mentioned, Y-shaped member 120 may be added to any crown that is to be flared upon expansion. In another embodiment of the present invention shown in
Preferably, the stent of the present invention is crimped onto a conventional balloon dilation catheter for delivery to a treatment site and expanded by the radial force of the balloon. Conventional balloon catheters that may be used in the present invention include any type of catheter known in the art, including over-the-wire catheters, rapid-exchange catheters, core wire catheters, and any other appropriate balloon catheters. For example, conventional balloon catheters such as those shown or described in U.S. Pat. Nos. 6,736,827; 6,554,795; 6,500,147; and 5,458,639, which are incorporated by reference herein in their entirety, may be used in conjunction with stent 100 of the present invention.
Deployment of balloon expandable stent 100 is accomplished by threading catheter 1303 through the vascular system of the patient until stent 100 is located within target tissue, for example, a lesion which may include plaque obstructing the flow of blood through the vessel. Once positioned, a source of inflation fluid is connected to inflation port 1311 of hub 1309 so that balloon 1307 may be inflated to expand stent 100 as is known to one of ordinary skill in the art. Balloon 1307 of catheter 1303 is inflated to an extent such that stent 100 is expanded or deployed against the vascular wall of the vessel to maintain the opening. Crowns 112 having Y-shaped members 120 will flare upon expansion and protrude into the vessel wall to anchor stent 100 within the vessel. Stent deployment can be performed following treatments such as angioplasty, or during initial balloon dilation of the treatment site, which is referred to as primary stenting.
However, rather than being balloon-expandable as described above, one of ordinary skill in the art can appreciate that stent 100 of the present invention can be adapted for any type of delivery method. For example, in another embodiment of the present invention, stent 100 may be self-expanding. Deployment of stent 100 may be facilitated by utilizing shape memory characteristics of a material such as nickel-titanium (nitinol). More particularly, shape memory metals are a group of metallic compositions that have the ability to return to a defined shape or size when subjected to certain thermal or stress conditions. Shape memory metals are generally capable of being deformed at a relatively low temperature and, upon exposure to a relatively higher temperature, return to the defined shape or size they held prior to the deformation. This enables the stent to be inserted into the body in a deformed, smaller state so that it assumes its “remembered” larger shape once it is exposed to a higher temperature, i.e., body temperature or heated fluid, in vivo. Thus, self-expanding stent 100 can have two states of size or shape, a contracted or compressed configuration sufficient for delivery to the treatment site and a deployed or expanded configuration having a generally cylindrical shape for contacting the vessel wall, wherein crowns 112 having Y-shaped members 120 will flare upon expansion of stent 100 and protrude into the vessel wall to anchor stent 100 within the vessel.
In another embodiment in which stent 100 is self-expanding, body portion 106 may be constructed out of a spring-type or superelastic material such as nickel-titanium (nitinol). A sheath (not shown) may be provided to surround and contain stent 100 in a contracted or compressed position. Once stent 100 is in position within the target vessel, the sheath may be retracted, thus releasing stent 100 to assume its expanded or deployed configuration. Crowns 112 having Y-shaped member 120 will flare upon expansion of stent 100 and protrude into the vessel wall to anchor stent 100 within the vessel.
Stent struts 110 of stent 100 may be made from a variety of medical implantable materials, including, but not limited to, stainless steel, nickel-titanium (nitinol), cobalt-chromium, tantalum, ceramic, nickel, titanium, aluminum, polymeric materials, nickel-cobalt alloy such as MP35N, titanium ASTM F63-83 Grade 1, niobium, platinum, gold, silver, palladium, iridium, combinations of the above, and the like. One widely used material for stents is stainless steel, particularly 316L stainless steel, which is particularly corrosion resistant. Once implanted, the metallic stent struts provides artificial radial support to the wall tissue.
Y-shaped member 120 may be made from the same or a different material from stent strut 110. In one embodiment, stent struts 110 and Y-shaped members 120 may be both formed from a plastically deformable material such as stainless steel that is expandable by the radial force of a balloon of a balloon dilation catheter. In another embodiment, stent struts 110 may be made from a plastically deformable material such as stainless steel that is expandable by the radial force of a balloon of a balloon dilation catheter while Y-shaped members 120 are formed from an elastically deformable material such as nickel-titanium (nitinol) or another shape memory or superelastic material. Forming Y-shaped members 120 from a superelastic material may assist in the expansion of Y-shaped members 120 to induce flaring of crowns. In yet another embodiment, it may be desirable to form Y-shaped member 120 from a bioabsorbable and/or biodegradable material that is selected to absorb or degrade in vivo over time. Bioabsorbable/biodegradable materials include magnesium or a magnesium alloy, other bioabsorbable metals, or bioabsorbable polymers such as polyactic acid, polyglycolic acid, collagen, polycaprolactone, hylauric acid, co-polymers of these materials, as well as composites and combinations thereof. Bioabsorbable Y-shaped members hold crowns of the stent in the flared configuration for a sufficient time to allow for endothelialization of the flared crowns of the stent strut. The term “endothelialization” is meant to describe the process in which a foreign object, such as the stent strut in embodiments of the present invention, becomes incorporated into the walls of the lumen by tissue ingrowth or encapsulation.
Stent 100 may not always be visible to a physician viewing, for example, an X-ray fluoroscopy device while deploying and/or positioning stent 100 into the vessel. Although not required, portions of the stent may be selectively plated with platinum or other biocompatible material to provide improved visibility during fluoroscopy. In one embodiment of the present invention, one or more radiopaque markers (not shown) may be attached to stent 100 at one or more predetermined locations. The marker may be formed of platinum or any other relatively heavy metal, which may be generally visible by X-ray fluoroscopy. For example, the marker may be attached to proximal end 102 or distal end 104 of stent 100 to allow a relatively high degree of accuracy for positioning stent 100 into the vessel.
In one embodiment of the present invention, at least a portion of stent 100 may be coated with a therapeutic agent (not shown). Stent 100 may be coated with a controlled-release polymer and/or drug, as known in the art, for reducing the probability of undesired side effects, e.g., restenosis. The therapeutic agent can be of the type that dissolves plaque material forming the stenosis or can be such as an antineoplastic agent, an antiproliferative agent, an antibiotic, an antithrombogenic agent, an anticoagulant, an antiplatelet agent, an anti-inflammatory agent, combinations of the above, and the like. Such drugs can include TPA, heparin, urokinase, or sirolimus, for example. Of course stent 100 can be used for delivering any suitable medications to the walls of a body vessel.
Stent struts 110 having select Y-shaped members 120 may be laser cut from stainless steel tubing, or any other appropriate tubing, having an outer diameter of approximately 0.25 inches and a wall thickness of approximately 0.012 inches. In this manner, the plurality of stent struts 110 having Y-shaped members 120 at crown locations may be formed connected together such that the stent body is a unitary structure. Alternatively, stent struts 110 may be laser cut from stainless steel tubing, or any other appropriate tubing, and Y-shaped members may be formed separately and attached to crowns 112 of stent struts 110. Y-shaped members may be attached via any suitable mechanical method, including welding, soldering, or by another mechanical method.
In addition, rather than being laser cut from any appropriate tubing material, stent 100 may be formed using any of a number of different methods that would be apparent to one skilled in the art. For example, stent struts 110 may be formed by winding a wire or ribbon around a mandrel to form a strut pattern like those described above and then welding or otherwise mechanically connecting two ends thereof to form a cylindrical ring 108. A plurality of cylindrical rings 108 formed in this manner are subsequently connected together to form the longitudinal tubular body of stent 100. Y-shaped members 120 may be formed separately and attached to crowns 112 of stent struts 110. Alternatively, stent struts 110 may be manufactured by machining tubing or solid stock material into toroid bands, and then bending the bands on a mandrel to form the pattern described above. Again, a plurality of cylindrical rings 108 formed in this manner are subsequently connected together to form the longitudinal tubular body of stent 100. Y-shaped members 120 may be formed separately and attached to one or more crowns 112 of stent struts 110. Chemical etching or another method of cutting a desired shape out of a solid stock material or tubing may also be used to form stent 100 of the present invention. In this manner, the plurality of stent struts 110 having Y-shaped members 120 may be formed connected together such that the stent body is a unitary structure. Further, stent 100 of the present invention may be manufactured in any other method that would be apparent to one skilled in the art. The cross-sectional shape of stent 100 may be circular, ellipsoidal, rectangular, hexagonal rectangular, square, or other polygon, although at present it is believed that circular or ellipsoidal may be preferable.
While various embodiments according to the present invention have been described above, it should be understood that they have been presented by way of illustration and example only, and not limitation. It will be apparent to persons skilled in the relevant art that various changes in form and detail can be made therein without departing from the spirit and scope of the invention. Thus, the breadth and scope of the present invention should not be limited by any of the above-described exemplary embodiments, but should be defined only in accordance with the appended claims and their equivalents. It will also be understood that each feature of each embodiment discussed herein, and of each reference cited herein, can be used in combination with the features of any other embodiment. All patents and publications discussed herein are incorporated by reference herein in their entirety.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US5458639||Aug 5, 1994||Oct 17, 1995||Medtronic, Inc.||Catheter balloon distal bond|
|US5957949||May 1, 1997||Sep 28, 1999||World Medical Manufacturing Corp.||Percutaneous placement valve stent|
|US6056776||Aug 17, 1998||May 2, 2000||Advanced Cardiovascular System, Inc.||Expandable stents and method for making same|
|US6066169||Jun 2, 1998||May 23, 2000||Ave Connaught||Expandable stent having articulated connecting rods|
|US6500147||Feb 22, 1999||Dec 31, 2002||Medtronic Percusurge, Inc.||Flexible catheter|
|US6554795||Feb 19, 1998||Apr 29, 2003||Medtronic Ave, Inc.||Balloon catheter and method of manufacture|
|US6736827||Oct 13, 2000||May 18, 2004||Medtronic Ave, Inc.||Low profile catheter|
|US6773455 *||May 3, 2001||Aug 10, 2004||Advanced Cardiovascular Systems, Inc.||Stent with reinforced struts and bimodal deployment|
|US6805705 *||Mar 31, 2003||Oct 19, 2004||Advanced Cardiovascular Systems, Inc.||Hybrid stent|
|US6846323||May 15, 2003||Jan 25, 2005||Advanced Cardiovascular Systems, Inc.||Intravascular stent|
|US20020123791||Dec 28, 2000||Sep 5, 2002||Harrison William J.||Stent design with increased vessel coverage|
|US20090216313 *||Feb 26, 2008||Aug 27, 2009||Helmut Straubinger||Stent for the positioning and anchoring of a valvular prosthesis|
|U.S. Classification||623/1.15, 623/1.17, 623/1.1, 623/1.3, 623/1.31, 623/1.16|
|Cooperative Classification||A61F2/91, A61F2230/0054, A61F2230/005, A61F2/915, A61F2/958, A61F2002/821|
|European Classification||A61F2/91, A61F2/915|
|Mar 27, 2008||AS||Assignment|
Owner name: MEDTRONIC VASCULAR, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:PELLEGRINI, GIANFRANCO;REEL/FRAME:020714/0284
Effective date: 20080325
|May 22, 2015||REMI||Maintenance fee reminder mailed|